Anemia amongst patients with heart failure - a review

Introduction Anemia and iron deficiency are common comorbidities in population with heart failure. Their association with unfavorable prognostic outcomes and diminished quality of life underscores the imperative need for accurate diagnosis and efficacious treatment interventions. In recent years numerous treatment options have been explored in clinical trials, aimed at addressing the multifaced aspects of these concurrent conditions. Summary In patients with heart failure effective treatment of anemia and iron deficiency has demonstrated enhancements in quality of life and exercise capacity. Findings from IRONMAN clinical study have prompted revisions in the latest guidelines from the European Society of Cardiology. The imminent release of results from two ongoing trials holds the potential to reshape the therapeutic landscape for treating individuals with heart failure and iron deficiency. Nevertheless, there is no explicit evidence that studied interventions could improve morbidity or risk of hospitalizations

Romheld's Gastrocardiac Syndrome, diagnosing a complex of cardiologic and gastroenterologic symptoms

In clinical practice among cardiac patients, symptoms of palpitations diagnosed as premature beats or episodes of atrial fibrillation (AF) are very frequently reported. One of the most common diseases in the field of gastroenterology is gastroesophageal reflux disease (GERD) . However, it may happen that the coincidence of the above-mentioned disease entities may predispose to the development of arrhythmias. In this article we describe the case of a 65-year-old man, without previously diagnosed diseases, in whom a clear association of arrhythmias with gastrointestinal complaints was observed. The presence of a burning sensation in the lower sternal region and typical symptoms resulting from esophagitis aggravated by triggers allows us to suspect esophageal reflux disease. Diagnostic tests performed for concomitant cardiac diseases did not reveal an organic cause of the arrhythmia. The recurrent course of symptoms observed in the present case and the analysis of the cause-effect course made us to diagnose gastrointestinal syndrome, also referred to as Romheld's Syndrome

The impact of physical activity on the risk and severity of COVID-19 infection

Introduction: A rapid outbreak of SARS-CoV-2 in the past few years caused a significant increase in the number of upper respiratory tract infections throughout the world. Numerous public health institutions tried to control the COVID-19 pandemic, including mandatory mask wearing, vaccinations, increased frequency of using disinfectants or compulsory lockdowns. Lockdown interventions were necessary, although they lead to insufficient, comparing to the international recommendations, levels of physical activity, which could trigger an elevated susceptibility to diseases of affluence. Purpose: Regular aerobic exercise may suppress inflammation, boost innate immunity and result in enhanced protection against viral infections. This review aims to show the relationship between level of physical activity and the risk and severity of COVID-19 infectio

Microvascular angina – an abstruse path to diagnose and to treat – a review of literature

Introduction: Chronic coronary syndrome is predominantly related to the atherosclerotic obstruction of the coronary artery or arteries. However, this phenomenon is not the only causative factor in this disease. It is usually forgotten, that there is a possibility of ischemia of the cardiac muscle with no obstruction found in the main vessel. The trigger of such pathology might be underlying in the microcirculatory system and the inappropriate dilation or constriction of those small vessels, which results in insufficient blood supply to the cardiomyocytes, similarly to the typical obstructive coronary artery disease. In this article we are willing to show that such dysfunction poses a great danger to the health and life and therefore we should be able to properly diagnose and treat it. Purpose of the work: The aim of this review of up-to-date literature is to raise awareness among both doctors and patients about the phenomenon of coronary artery disease but with no significant obstruction in the vessels supplying the cardiac muscle. The common cause of such condition is coronary microvascular dysfunction, that leads to a disease called microvascular angina. Our purpose was to reveal, how dangerous to the health of the patients this could be and therefore how essential it is to provide a proper diagnose and management. In addition, we have noticed a need for a summary of what has already been discovered on this topic, available therapeutic methods and future perspectives

How to deal with pain in the emergency department - pain management review

One of the primary health issues bringing patients to hospital emergency rooms is pain. It is often treated inadequately. Doctors working in the emergency department have the option of using a number of drugs for analgesia. The three main groups include non-steroidal anti-inflammatory drugs, non-opioid analgesics and opioid analgesics. In order to properly exploit their potential, it is necessary to properly classify the pain, know the basic action of the available drugs, choose the right dose, and know how to combine drugs from different groups to achieve balanced analgesia. By acting in this way, the patient in the hospital emergency department will be properly provided with medication, and this will have a positive effect on his overall health

Long-term survival and nearly asymptomatic course of carcinoid tumour with multiple metastases (treated by surgery, chemotherapy, 90Y-DOTATATE, and LAR octreotide analogue): a case report

Carcinoids are the most common neuroendocrine tumours. They are usually slowly growing, located in the small intestine, secrete serotonin, and are characterized by long survival of patients, so prognosis is generally good. The most frequently encountered clinical presentations of carcinoids are intermittent abdominal pain and carcinoid syndrome (diarrhoea and flushing). Metastases worsen the prognosis and limit the survival of the patients. We report a case of carcinoid tumour with primary focus in the ileum, with an appendix infiltration, in a thirty-two-year-old woman with acute appendicitis symptoms only. Carcinoid was diagnosed postoperatively by histopathological examination. Nowadays, twenty-five years after the surgery, there is evidence of nearly asymptomatic numerous metastases. Only intermittent abdominal pain for about 1-2 years was reported. Partial metastases resection was performed, followed by chemotherapy, 90Y-DOTATATE and then long-acting release octreotide analogue therapy. In the meantime, severe chronic heart failure (NYHA IV) due to tricuspid combined valvular heart disease and pulmonary hypertension was diagnosed. Combined therapy, typical for chronic heart failure, together with long-acting octreotide analogue highly improved the patient’s heart sufficiency and reduced carcinoid syndrome symptoms. The only adverse events of octreotide therapy were hyperbilirubinaemia and itching. Long-term survival is typical for carcinoids, but 30-years survival has not been described in the literature yet.Rakowiak jest jednym z najczęstszych guzów neuroendokrynnych. Umiejscawia się w obrębie jelita cienkiego, zazwyczaj jako wolno rosnący guz wydzielający serotoninę. Pacjentów chorych na rakowiaka charakteryzuje długie przeżycie i dobre w większości przypadków rokowanie. Najczęstszymi objawami tego nowotworu są nawracające bóle w jamie brzusznej i objawy zespołu rakowiaka (biegunka i napadowe zaczerwienienia skóry - "flush"). Pojawienie się przerzutów pogarsza rokowanie oraz skraca czas przeżycia chorych. Opisany przypadek dotyczy 32-letniej kobiety z pierwotnym ogniskiem rakowiaka zlokalizowanym w jelicie krętym, naciekajacym wyrostek robaczkowy z objawami ostrego zapalenia wyrostka robaczkowego. Rakowiak został zdiagnozowany pooperacyjnie na podstawie oceny histopatologicznej. Dwadzieścia pięć lat po zabiegu operacyjnym wykryto prawie bezobjawowe liczne ogniska przerzutowe. Chora w wywiadzie wymieniła jedynie nawracające bóle w jamie brzusznej w okresie 1-2 lat przed rozpoznaniem przerzutów. W trakcie zabiegu operacyjnego usunięto część guzów przerzutowych, a następnie poddano pacjentkę chemioterapii, leczeniu 90Y-DOTATATE, a następnie preparatami oktreotydu LAR. W międzyczasie rozpoznano przewlekłą, ciężką niewydolność serca (NYHA IV) w przebiegu złożonej wady zastawki trójdzielnej serca oraz nadciśnienia płucnego. Złożona terapia, typowa dla przewlekłej niewydolności serca razem z długodziałającym analogiem oktreotydu znacznie poprawiły wydolność serca oraz zredukowały objawy zespołu rakowiaka. Jedynym działaniem niepożądanym terapii oktreotydem były hiperbilirubinemia oraz świąd. Długi okres przeżycia jest typowy dla rakowiaka, jednak 30-letnie przeżycie nie było dotychczas opisywane w literaturze

Charakterystyka modeli in vitro do badań nad rakiem jajnika

W leczeniu onkologicznym coraz większą rolę odgrywają leki celowane molekularnie. W terapii raka jajnika najbardziej obiecujące wyniki daje zastosowanie leków z grupy inhibitorów polimerazy poliADP-rybozy (PARP). Badania kliniczne ostatnich lat wykazały, że inhibitory PARP stosowane w terapii podtrzymującej wydłużają czas wolny od progresji o wiele miesięcy. To zachęca do poszukiwania kolejnych leków celowanych i stwarza nadzieję, że rak jajnika może się stać chorobą przewlekłą, o wieloletnim przebiegu.Problemem w badaniach nad rakiem jajnika jest heterogenność choroby. Ostatnie badania wskazują, że różne typy histologiczne mogą mieć odrębne pochodzenie tkankowe. Według współczesnej wiedzy określenie „rak jajnika” jest sztucznym pojęciem, obejmującym różne inwazyjne raki zlokalizowane w obrębie miednicy. Badania genetyczne i immunofenotypowe wskazują, że niskozróżnicowany rak surowiczy, najczęstszy i najgorzej rokujący typ histologiczny, w większości przypadków wywodzi się z nabłonka jajowodu, raki endometrioidalne i jasnokomórkowe wywodzą się zaś prawdopodobnie z endometrium. Dlatego w badaniach podstawowych i przedklinicznych nad rakiem jajnika potrzebne są dobrze scharakteryzowane modele odpowiadające poszczególnym typom histologicznym.W niniejszej pracy omówiono najczęściej wykorzystywane linie komórkowe stosowane w badaniach in vitro. Opracowanie ma na celu podsumowanie zalet i ograniczeń różnych modeli, obejmujących hodowle pierwotne i stabilne linie komórkowe, model hodowli dwu- i trójwymiarowej itp. W szczególności autorzy chcą zwrócić uwagę badaczy, że najczęściej stosowane linie komórkowe SKOV3 i A2780 nie są właściwym modelem do badań nad niskozróżnicowanym rakiem surowiczym

Characteristic of cells isolated from human Abdominal Aortic Aneurysm samples cultured in vitro

Abstract Background: This study aimed to standardize cell culture methods for major cell types isolated from three layers of human AAA. We also aimed to determine cell types in each layer of each AAA segment and compare them with cell types in layers of control, unchanged segments. Material and methods We divided AAAs into three segments along the AAA and control segments flanking the aneurysm. Isolated cells following expansion were analyzed by flow cytometry, immunochemistry and microscopic methods. Fluorochrome-conjugated antibodies were used to detect the three major cell types (endothelial cells, smooth muscle cells, and fibroblasts) in each layer of every AAA segment. Results: Culture of cells from the three AAA segments was successfully established in 21% of patients. In all of the layers, only a small proportion of cells showed layer- specific markers of cell types. The majority of cells from every layer were positive for CD90, which is considered specific marker of fibroblasts in the aorta. Conclusions: We describe methodology for isolation of cells, their culture conditions, and phenotypic characterization for AAA. The wall of AAA loses its specific types of cells in all of the layers compared with the normal abdominal aortic wall

Impact of the putative cancer stem cell markers and growth factor receptor expression on the sensitivity of ovarian cancer cells to treatment with various forms of the HER inhibitors and cytotoxic drugs

Increased expression and activation of human epidermal growth factor receptor (EGFR) and HER-2 have been reported in numerous cancers. The aim of this study was to determine the sensitivity of a large panel of human ovarian cancer cell lines (OCCLs) to treatment with various forms of small molecule tyrosine kinase inhibitors (TKIs) and cytotoxic drugs. The aim was to see if there was any association between the protein expression of various biomarkers including three putative ovarian cancer stem cell (CSC) markers (CD24, CD44, CD117/c-Kit), P-glycoprotein (P-gp), and HER family members and response to treatment with these agents. The sensitivity of 10 ovarian tumour cell lines to the treatment with various forms of HER TKIs (gefitinib, erlotinib, lapatinib, sapitinib, afatinib, canertinib, neratinib), as well as other TKIs (dasatinib, imatinib, NVP-AEW541, crizotinib) and cytotoxic agents (paclitaxel, cisplatin and doxorubicin), as single agents or in combination, was determined by SRB assay. The effect on these agents on the cell cycle distribution, and downstream signaling molecules and tumour migration were determined using flow cytometry, western blotting, and the IncuCyte Clear View cell migration assay respectively. Of the HER inhibitors, the irreversible pan-TKIs (canertinib, neratinib and afatinib) were the most effective TKIs for inhibiting the growth of all ovarian cancer cells, and for blocking the phosphorylation of EGFR, HER-2, AKT and MAPK in SKOV3 cells. Interestingly, while the majority of cancer cells were highly sensitive to treatment with dasatinib, they were relatively resistant to treatment with imatinib (i.e., IC50 >10 µM). Of the cytotoxic agents, paclitaxel was the most effective for inhibiting the growth of OCCLs, and of various combinations of these drugs, only treatment with a combination of NVP-AEW541 and paclitaxel produced a synergistic or additive anti-proliferative effect in all three cell lines examined (i.e., SKOV3, Caov3, ES2). Finally, of the TKIs, only treatment with afatinib, neratinib and dasatinib were able to reduce the migration of HER-2 overexpressing SKOV3 cells. We did not find any significant association between the expression of putative ovarian CSC marker, HER family members, c-MET, ALK, and IGF-IR and the response to the irreversible HER TKIs. Our results support the need for further investigations of the therapeutic potential of these irreversible HER family blockers in ovarian cancer, and the therapeutic potential of dasatinib when used in combination with the inhibitors of the HER family members in ovarian cancer

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population